User Manual (Regional Infection Control Assessment Tool) Attachment 1

Regional Infection Control Assessment Tool

Regional Infection Control Assessment Tool

for Infection Control Link Persons

in Lesser-Resourced Settings

December 2009

Regional Infection Control Assessment Tool

Table of Content

Topic / Page
User Manual / 1
Introduction / 1
Objectives / 1
Structure of the assessment tool and the assessment process / 1
Reporting / 2
Annotations and recommended practices / 2
References / 6
Further readings / 6
Assessment Tool / 7
Report Template / 13

Regional Infection Control Assessment Tool

User Manual

Introduction

Healthcare-associated infection (HAI) is a medical and economic problem of global importance. The infection surveillance and control resources and activities play a key role in limiting morbidity and mortality due to nosocomial infection. To prevent and control hospital infections, it is necessary to have adequately trained staff, responsive infrastructure and substantial financial resources. However, the availability of these resources varies from countries to countries. Therefore, efforts to address infection control and prevention issues in a given situation must take into account the different cultural, social, and economic realities of each country.

Nurses, as part of the healthcare team, play a vital role in the prevention of HAI. They can intervene directly to prevent infections; educate and raise awareness of healthcare workers; develop and recommend policies and procedures; and manage critical data and information. In lesser-resourced countries, implementation of infection prevention and control programs is frequently affected by such thing as financial constraints, sterilization procedures, and inadequate staff training. In these settings, nurses can contribute in detecting deficiencies in infection control practices, as well as recommending and implementing effective, affordable solutions.

Objectives

This assessment tool is designed for use in lesser-resourced countries and settings, and may be used at national, district/regional, or healthcare facility level. It aims to provide policy-makers, health facility administrators and infection preventionist, as well as partner agencies with comprehensive, standardized data sets, by which to analyze policy gaps and options, as well as to measure progress and outcomes achieved in relation to addressing the multiple factors contributing to nosocomial infection risks.

Structure of the assessment tool and the assessment process

The tool consists of 13 sections for assessing infection prevention and control activities and resources. Each section consists of groups of questions mostly answered by yes/no/na responses. The assessment is intended to be constructive and it is vital to note that the assessment tool is not intended to be a test. Completing the tool helps identify areas in which existing practices or resources are generally satisfactory or where there are issues that should be addressed with new policies or programs.

The surveyor should be nurses or other healthcare professionals with a background or understanding of issues in infection control. The surveyor should meet with relevant counterparts to explain the specific objectives of the assessment, gain their understanding and approval, and provide them with a copy of the assessment tool for their reference.

For country level assessment, the data collection should ideally take place over a two-week period. The surveyor should interview relevant counterparts, which include key national level government health administrators, health educators, and other stakeholders to establish an understanding of national infrastructure and networks, and examine national policy and directives. The surveyor should also undertake site visits to key education/training institutions, and national, regional and rural healthcare facilities. Data can be collected through face-to-face interviews, open discussions, and observation of clinical practice using the assessment tool as a guide. Infection prevention and control reports as well as curricula for the education/training of all healthcare workers are useful information in the facilities visited. For self-assessment of a healthcare facility, data collection process should occur within a week. Hospital leaders and staff who best represent relevant areas should be included in the assessment. Data collection methods used in country level assessment can be adapted whenever appropriate.

Reporting

The report should clearly highlight the issues that require urgent short term rapid action that will have the most significant impact on immediate patient safety and public health protection. Recommendations should always promote evidence-based practice whilst recognizing resources limitations. The report should be presented using the reporting template included in this document.

Annotations and recommended practices

The following are annotations and recommended practices that are based on WHO publications. These serve as a reference for comparing local practices with internationally accepted standards.

Infection Control Assessment Checklist / Annotations and Recommended Practices
National policies for Infection Control
Policy has been signed and ratified by the Minister of Health or appropriate authority / There should be a unit within the Ministry of Health responsible for update, review and monitoring of the Infection Prevention and Control Policies and Guidelines (Infection Control Guidelines, p8).
Policy has been directly disseminated to:
District/regional healthcare managers
Public health facility managers
Private healthcare facility managers
Healthcare academic and training facilities / District/Regional Health Authorities are responsible for monitoring the facilities and adherence with Infection Prevention and Control (Infection Control Guidelines, p8).
Organization of Infection Control
Who is responsible for IC in the hospital / The hospital administrator/head of hospital should establish an infection control committee and appoint an infection control team (Practical Guidelines for Infection Control in Healthcare Facilities, p6).
Are IC guidelines available? / The existence of guidelines provides a framework to implement evidence-based practices (Core Components for infection prevention and control programmes, p12)
Is there an IC committee? / An infection control committee should provide a forum for multidisciplinary input and information sharing (Practical Guidelines for Infection Control in Healthcare Facilities, p6-7).
Is there an Infection Control team? / The infection control team appointed by IC committee is responsible for infection control programme (Practical Guidelines for Infection Control in Healthcare Facilities, p7-8).
How many IC specialists/IC nurses? / 1.5 ICPs to 200 acute health care beds in a hospital (Infection Control Guidelines, p15).
Did they receive specific IC training e.g. Certificate course? Pre-service training? In-service education? / It is recommended that training through awareness programmes, in-service education and on-the-job training should be provided (Practical Guidelines for Infection Control in Healthcare Facilities, p9).
Training repeated? How often per year? / Training is an ongoing process, should provide frequent training programmes (Infection Control Guidelines, p139).
Is educational IC material available (e.g., textbook,video, fact sheets, posters)? / Print materials, such as posters and fact sheets can increase the impact of training (Infection Control Guidelines, p144).
Is there an Influenza vaccination plan for HCW? Other vaccination programmes? / Plan for priority groups and mass vaccination must be considered (Infection Control Guidelines, p133).
Clinical specialties
Is there an isolation room? / Isolation rooms in ward/unit layout should minimize traffic and transport into adjacent patient care areas (Infection Control Guidelines, p116).
Is there a fever ward/clinic / Allow patients with epidemiological and clinical information suggestive of a similar diagnosis to share rooms, and with a spatial separation of at least 1 m from one another (Infection Prevention and Control of Epidemic and Pandemic Prone Acute Respiratory Diseases in Health Care, p22).
Epidemic preparedness
Is there an epidemic contingency plan in place? / Planning for epidemics within the health care services must be done on a collaborative basis (Infection Control Guidelines, p131).
Training for HCW: Preparedness for infection? Diseases emergencies? / Training of HCW is required. HCW should understand the epidemiological principles for how infection and disease is spread (Infection Control Guidelines, September, pp130-1, 133).
Back-up staff? / Back-up strategies like alternative laboratory services should be considered (Infection Control Guidelines, p133).
Clinical management
(Standard Operating Procedures)
Does the hospital have a clinical management plan for infectious patients in place, including:
Case definitions / Classified as a case in terms of diagnosis (Infection Control Guidelines, p136).
General Infection Control practices
Running water? / Access to clean water is essential (Practical Guidelines for Infection Control in Healthcare Facilities, p77).
Soap? / Plain or antimicrobial soap (Practical Guidelines for Infection Control in Healthcare Facilities, p77).
Ratio of sinks per beds? / Hand washing basin placement ratios (Infection Control Guidelines, p115).
Alcoholic hand rub? / Alcohol hand rub is appropriate for hand decontamination between patient contacts (Infection Control Guidelines, p25).
Ratio of alcoholic hand rub per beds? / Should be placed outside each patient room (Practical Guidelines for Infection Control in Healthcare Facilities, p78).
Education of HCW for hand hygiene? / Should focus on factors significantly influence behaviour (Infection Control Guidelines, p25).
Recapping practiced? / Recap needles is not recommended but if recapping is necessary should use a one hand technique (Infection Control Guidelines, p83).
Sharps containers available? / Puncture-resistant container with a lid should be provided (Practical Guidelines for Infection Control in Healthcare Facilities, p15).
Incineration of sharps? / Needles, syringes should destroy by incineration (Prevention of hospital acquired infections – A practical guide, p45).
Other means of sharps destruction? / Destroyed follow the national standards or guidelines (Practical Guidelines for Infection Control in Healthcare Facilities, p15).
General waste management
Definition of infectious waste? / Waste suspected to contain pathogens (Prevention of hospital acquired infections – A practical guide, p53).
Incineration? Type of incinerator? / Incineration is the best way to destroy contaminated waste (Infection Control Guidelines, p86 ).
Surveillance of health care associated infections
Does the hospital have a surveillance system for hospital acquired infections in place? / Valid surveillance system is an important hospital function (Prevention of hospital acquired infections – A practical guide, p17).
Reporting to whom? Reporting mechanism in place to CDC/country/provincial level? / Reporting may include meetings, microbiological review (Prevention of hospital acquired infections – A practical guide, p23).
Isolation of infectious patients
Drills/test runs for managing isolated infectious cases conducted? Including training with PPE? / HCWs must understand the principles relating to Standard and Transmission Based Precautions, including use PPE correctly (Infection Control Guidelines, p130).
Single isolation rooms available? How many? / If an air-conditioned single room is not available in poor resources areas, a fan can be placed in the room to direct airflow towards an outside window (Practical Guidelines for Infection Control in Healthcare Facilities, pp19-20).
Ante-room for changing and storage of supplies? / For storage of personal protective equipment (Practical Guidelines for Infection Control in Healthcare Facilities, p18).
Toilet/bathing facilities for each single room and cohort room? / Single room with toilet, hand basin and bathing facilities should be provided (Infection Control Guidelines, p116).
Dedicated patient care equipment for patients in isolation / Dedicated equipment and linen should store in the room (Infection Control Guidelines, p116).
Ventilation of isolation room
Negative pressure / Negative pressure is required for isolation of patients with infections spread by airborne route (Practical Guidelines for Infection Control in Healthcare Facilities, pp20-21).
Centralized air conditioning / Air conditioning should exhaust to outside in negative pressure room (Infection Control Guidelines, p116).
Door able to be closed / The door to the aisle or other rooms should be kept closed (Practical Guidelines for Infection Control in Healthcare Facilities, p21).

References

World Health Organization (WPRO Region). (2004). Practical guidelines for infection control in healthcare facilities. Geneva: WHO (SEARO Regional Publication No. 41).

World Health Organization. (2002). Prevention of hospital acquired infections – A practical guide. Geneva: WHO (Document no. WHO/CDS/EPH/2002.12).

World Health Organization (WPRO region). (2007). Infection control guidelines. Geneva: WHO.

World Health Organization (2007). Infection Prevention and Control of Epidemic and Pandemic Prone Acute Respiratory Diseases in Health Care, Geneva: WHO (Document no.WHO/CDS/EPR/2007.6).

World Health Organization (2009). Core components for infection prevention and control programmes. Geneva: WHO (Document no. WHO/HSE/EPR2009.1).

Assessment Tool

Country

Region

Date Commenced / / Date Completed /
Surveyor Name
Designation
Contact Address /
Telephone / / Facsimile /
Mobile
Email

Regional Infection Control Assessment Tool

Counterpart details/persons met

Name / Designation / Address / Telephone / Facsimile / Mobile phone / Email

Regional Infection Control Assessment Tool

Yes/No/NA / Comments
Infrastructure of Infection Control (IC)
Hospital Name:
Level (district, provincial, university hospital);
No. of division/department:
No. of wards:
No of beds:
Occupancy rate:
No. of doctors:
No of nurses:
No. of Health Officers/Assistants
National Policies for Infection Control
Policy has been signed and ratified by the Minister of Health or appropriate authority
Consultation was sought from experts in the field of infection control
Policy has been directly disseminated to:
District/regional healthcare managers
Public health facility managers
Private healthcare facility managers
Healthcare academic and training facilities
Organization of Infection Control in the Hospital
Who is responsible for IC in the hospital? Please identify:
Are IC guidelines available?
Is there an IC committee1?
How many members:
What are their duties:
Meeting: How often per year?
Is there an Infection Control team2?
How many members:
What are their duties:
How many IC professionals3?
How many IC nurses?
How many are full time?
Did they receive specific IC training
e.g. Certificate course? Pre-service training? In-service training?
Training repeated? How often per year?
Is educational IC material available (e.g., textbook, fact sheets, posters)?
Is there an Influenza vaccination plan for HCW?
Other vaccination programmes for HCW? Please specify:

1 IC committee belongs to either a government or private health care facility with members coming from a variety of departments. Its functions are to monitor, coordinate and evaluate infection prevention and control.

2 Appointed by IC committee and the team is mainly responsible for infection control programme.

3 These IC professionals include physicians, nurses and other health care professionals. They are responsible for the infection control and prevention activities at any level.

Regional Infection Control Assessment Tool

Yes/No/NA / Comments
Financing of Infection Control
Are funds available for improving IC?
Where do the funds come from?
If funds were available, in which area would funds be invested (e.g. training, equipment)?
Are funds available for providing staff with PPE and other IC material?
Clinical specialties in Infection Control
Is this a designated infectious disease hospital?
Is there an infectious diseases ward?
Is there an isolation ward?
Is there an isolation room?
Is a microbiological laboratory available?
Time from specimen collection to results?
Please indicate:
Viral isolates?
Bacterial isolates?
Is there a fever clinic4?
Is there a fever ward/cubicle5?
Epidemic preparedness
Is there an epidemic contingency plan in place?
Training for HCW: Preparedness for infection diseases emergencies?
Plans for quarantine?
Is there a back-up hospital?
Back-up staff?
Clinical management (Standard Operating Procedures)
Does the hospital have a clinical management plan for infectious patients in place, including:
Case definitions
Admission plan, e.g. isolation
Diagnostic protocols
Protocol for clinical investigation
Treatment plan
Patient transfer to isolation rooms?
General Infection Control practices
Running water?
Soap?
Ratio of sinks per beds?
Alcoholic hand rub?
Ratio of alcoholic hand rub per beds?
Education of HCW for hand hygiene?
How much alcoholic hand rub is used per year?
Implement Standard Precautions?
Programme to prevent sharps injuries?

4 Designated fever clinic, i.e. for feverish patients only